Physicians insert 5 million central lines annually in the United States. Mechanical complications occur in 10- 30% of insertion attempts extrapolating to 50,000-150,000 adverse events per year. The incidence of catheter related infections in the intensive care unit (ICU) ranges between 1.2-4.5/1000-catheter days. Several approaches to minimize the number of adverse events exist such as utilizing ultrasound guidance for venous cannulations, stringent adherence to aseptic techniques, and avoidance of high-risk insertion sites. However, as the population increasingly uses emergency department (ED) services, the importance of understanding the extent of these interventions on ED care remains unknown due to a dearth of data on processes that begin with ED care and extend throughout the hospital. The purpose of this career development award is to allow the candidate to develop further analytic and practical skills in the areas of patient safety, clinical outcomes, and decision analysis. The short-term career development goal during this award is to complete a Masters of Science in Clinical Investigation through Washington University in St. Louis'Clinical Research Training Center (CRTC). The long-term goal is to improve the assessment of the global clinical and economic impact of interventions in the ED on the outcomes of the population who use and rely on Emergency Medicine services. In order to develop the practical skill set, we propose a randomized controlled trial to assess outcomes of subclavian vein cannulations with and without ultrasound assistance in ED patients admitted to the hospital. We propose to use large administrative databases to quantify the procedure density of central lines placed in the ED to assist in extrapolating national patient safety data. Our final research goal is to develop a decision-analysis model integrating patient safety and cost data of central line adverse events. The objective is to demonstrate that the ED plays an integral role in improving the outcomes and quality of central venous cannulation. The overall goal is to develop the candidate into an independent investigator who can implement multidisciplinary approaches to analyze the impact of ED interventions on the health care system.